摘要
目的探讨早期应用乌司他丁(UTI)治疗急性重度一氧化碳中毒(ASCMP)脑损伤的临床疗效。方法选取哈励逊国际和平医院重症监护室2020年2月至2023年2月收治的ASCMP患者210例,根据治疗方案的不同分为常规组90例和观察组120例。观察组在常规治疗基础上给予UTI注射液30万单位+5%葡萄糖注射液100ml,静脉滴注,8·h^(-1),连续14d。分别于治疗前,治疗后5d、14d,检测内皮素-1(ET-1)、多配体蛋白聚糖-1(SDC-1)、透明质酸(HA)、血栓调节蛋白(TM)、S100钙结合蛋白β(S100B)、神经元特异性烯醇化酶(NSE)以及监测脑电双频指数(BIS)。记录美国国立卫生研究院卒中量表(NIHSS)评分和蒙特利尔认知评估量表(MoCA)评分。结果治疗后,观察组总有效率高于常规组,差异有统计学意义(χ^(2)=4.269,P=0.033)。观察组昏迷时间短于常规组,平均住院天数较常规组减少,差异有统计学意义(P<0.05)。治疗前,两组SCD-1、HA、TM、ET-1、S100β、NSE、NIHSS评分升高,BIS、MoCA评分降低,组间比较差异无统计学意义(P>0.05)。治疗后5d,SCD-1、HA、TM、ET-1、S100β、NSE、NIHSS评分低于治疗前,BIS评分、MoCA评分高于治疗前,治疗后14 d,SCD-1、HA、TM、ET-1、S100β、NSE、NIHSS评分低于治疗后5 d,BIS评分、MoCA评分高于治疗后5 d,观察组各检测指标改善均优于常规组,差异有统计学意义(P<0.01)。采用Logistic逐步回归,结果显示:SCD-1、HA升高、BIS降低的ASCMP患者发生持续性神经精神后遗症(PNS)的危险因素升高。结论UTI通过改善血管内皮功能及减轻内皮糖萼脱落来降低血-脑脊液屏障(BCFB)通透性,降低S100β、NSE,提高BIS,促进神经功能损伤的恢复,降低PNS的发生。
Objective To investigate the clinical effect and mechanism of ulinastatin(UTI)in the treatment of severe acute carbon monoxide poisoning(ASCMP).Methods 210 patients with ASCMP admitted to our hospital from February 2020 to February 2023 were selected and divided into the conventional group(90 cases)and the observation group(120 cases)according to different treatment regimens.Observation group was given UTI injection 300,000 units+5% glucose injection 100 ml intravenously,once 8·h^(-1),for 14 days.Endothelin-1(ET-1),polyligand proteoglycan-1(SDC-1),hyaluronic acid(HA),thrombomodulin(TM),S100 calc-binding protein β(S100β),neuron-specific enolase(NSE)and BIS were detected before treatment,5 and 14 days after treatment,respectively.National Institutes of Health Stroke Scale(NIHSS)scores and Montreal Cognitive Assessment Scale(MoCA)scores were recorded.Results After treatment,the total effective rate of observation group was higher than that of conventional group,and the difference was statistically significant(χ^(2)=4.269,P=0.033).The coma time in the observation group was shorter than that in the conventional group,and the average hospitalization days were reduced,the difference was statistically significant(P<0.05).Before treatment,the scores of SCD-1,HA,TM,ET-1,S100β,NSE and NIHSS were increased,while the scores of BIS and MoCA were decreased between the conventional and observation groups,and there was no statistical difference between the two groups(P>0.05).5 days after treatment,the scores of SCD-1,HA,TM,ET-1,S100β,NSE and NIHSS were lower than before treatment,and the scores of BIS and MoCA were higher than before treatment.14 days after treatment,the scores of SCD-1,HA,TM,ET-1,S100β,NSE and NIHSS were lower than 5 days after treatment.BIS score and MoCA score were higher than 5 d after treatment,and the improvement of each detection index in the observation group was better than that in the conventional group,with statistical significance(P<0.01).Logistic stepwise regression showed that ASCMP patients with increased SCD-1 and HA and decreased BIS had increased risk factors for PNS.Conclusion UTI reduces blood-brainspinal fluid barrier(BCFB)permeability,reduces S100β and NSE,increases BIS,promotes recovery of nerve function injury,and reduces PNS by improving vascular endothelial function and alleviating glycocalyces shedding.
作者
杨蕊
李伟
李敬
Yang Rui;Li Wei;Li Jing(Department of Critical Care Medicine,Harrison International Peace Hospital,Hebei 053000,China)
出处
《脑与神经疾病杂志》
2025年第1期44-48,共5页
Journal of Brain and Nervous Diseases
基金
2018年度河北省医学科学研究重点课题(20181600)。
关键词
急性重度一氧化碳中毒
脑损伤
乌司他丁
治疗
Acute severe carbon monoxide poisoning
Brain injury
Ulinastatin
Treatment
